Provider Demographics
NPI:1972258523
Name:O'BRIEN, MALLORY PAIGE (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:PAIGE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:028-829-3795
Mailing Address - Fax:502-805-0526
Practice Address - Street 1:5170 CHARLESTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8400
Practice Address - Country:US
Practice Address - Phone:812-590-8888
Practice Address - Fax:812-590-8890
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014513A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist